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Chasing the missing patient
114 Plays10 hours ago
Miranda and Josh address the sensitive topic of what happens when a patient goes missing from treatment. They discuss the importance of follow-up, including how often to reach out and the best practices for re-engaging patients.
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Transcript
Introduction by Josh and Miranda
00:00:05
josh MacDonald
Hi, I'm Josh McDonald.
00:00:07
Miranda Materi
I'm Miranda Maturi and we are Hand Therapy Academy.
00:00:10
josh MacDonald
Let's talk today about some patient dynamics. um Specifically, like how long should you chase that patient who's just not coming in?
Challenges in Therapy Attendance
00:00:18
josh MacDonald
and The missing patient report that we fill out and we get patients who haven't been in in two weeks or maybe a week and there's just a struggle to get them to show up to their appointments.
00:00:27
josh MacDonald
How long do you work to chase them? So Miranda, do you guys have like ah a clinic policy on that? Is it like patient by patient?
00:00:34
Miranda Materi
Yeah, usually give them two two calls so we'll call them twice and then we document it and then we'll send a note to whoever sent the referral to us with that being said though i always encourage the therapist who has a relationship with that patient to text or call them as well and just check in and see how they're doing but typically after two we say we're good unless there's something you know that we're really worried about or something's a little bit off um Then we'll spend a little bit more time at it. How about
Policy on Patient Outreach
00:01:05
Miranda Materi
you guys? What do you do?
00:01:07
josh MacDonald
If they're, if they're just not coming in or they aren't rescheduling to come in. Yeah. Then we have like a, we'll call them two, maybe three times as just like a general starting point policy, but it's really on a patient case by case basis. Like we have patients where it's a huge trauma or, you They really need to come in because of functional limitations. And so we'll maybe push a little bit harder with those.
00:01:29
josh MacDonald
Sometimes it has to do with how busy we are as a clinic. If I've got my therapist sitting around doing nothing, I'll say like, all right, go through patients that haven't been in a while and just reach out. Because if they come in once and then don't come in again, maybe they get a new home program update.
00:01:41
josh MacDonald
But just you've got the time. Why not reach out to those patients? So it it may be based on us too a little bit.
00:01:46
Miranda Materi
Yeah. And I think, like you said, it also depends, like sometimes there's a lot of people we worry about, right? Like i remember being a therapist and be like, I haven't seen them in two or three weeks and I'm genuinely worried. Like, are they okay? What happened? We haven't heard from them. So even if it's not, you know, you know, necessarily like, oh, I'm really worried about the rest. I'm worried about them as a person. Right. I feel like sometimes we get to really know our patients and you do start to worry.
00:02:10
josh MacDonald
Yeah. One of our clinics is in a high retirement area, lots of um retirement communities. And so for us, it's this, are they still doing okay? Right? Like we haven't seen Florence in a long time. It's been a couple of weeks.
00:02:22
josh MacDonald
They're not returning calls. And we've had more than once where we called and ah child, like they one of their adult kids answered the phone and said, they're in the hospital. They've passed away. Like, you know, those so those things, those things do happen. So it's good to, you know, still kind of follow up out of concern for those patients for sure.
Unique Challenges for Burn Patients
00:02:37
Miranda Materi
Yeah, definitely.
00:02:39
josh MacDonald
i have We have ah a friend a mutual friend of ours who works in a burn unit here in Phoenix, in the Maricopa County burn unit. And he said something, it was years ago, he said something to me and I like, you know, that kind of resonates with me a little bit. Then I hadn't really like put words to it.
00:02:53
josh MacDonald
We had a pay patient, he'd referred to us and I said, hey, just a headup heads up, this guy's not coming back. We've called, he's came once or twice and he's just not coming back. The burn population kind of tends to do that.
00:03:03
josh MacDonald
um It's the nature of the person who's likely to get a burn injury may not also be making good life choices about coming in for therapy and keeping up with life things. And he's like, you know, it's their hand. We can only chase him so much.
00:03:15
josh MacDonald
It's their hand.
00:03:15
Miranda Materi
Thank you.
00:03:15
josh MacDonald
They're making their choices.
Patient Responsibility and Boundaries
00:03:17
josh MacDonald
And i think i think he might have been a little jaded about about his caseload in general. But I thought, you know what? Yeah, it is like I can't care. more about your injury and your hand than you do.
00:03:29
josh MacDonald
Like you've got to take ownership of that. And I had to kind of create that professional boundary for myself.
00:03:34
Miranda Materi
Yeah, it can be difficult, right? Especially when as a therapist, you really invested a lot in that patient, right? And you you invest your time thinking about them, thinking about what program you're going to do with them, how you're going to reach those goals with them. And and if that's not their goal, it's not their goal and you can't make that their goal.
00:03:51
josh MacDonald
Yeah. Yeah. And I can't make it happen. I can't make them come in. And sometimes they can't come in. Like there's a fair number of patients. You've got a single mom working with two kids and life is crazy. And we think this is her biggest priority.
00:04:07
josh MacDonald
She's got to pay the electric bill and get her kids to school and keep everybody fed. Like this may not be her number one priority. So maybe we need to flex around that person a little bit and say, all right, every other week is maybe all i'm going to get with you. And I'll put you on a, like on a,
00:04:20
josh MacDonald
Same day visit notice when we have this where like you call us and at any time you call, we'll find a place to put you because we know it's all we're going to get. So we for some of those patients, we work around them a little bit more if it's just their limitation.
00:04:34
Miranda Materi
Yeah. And then another thing I would encourage if you have a patient that's not showing up or maybe they're not seeing the value in the services we're providing. Right. So I think that's another thing to be aware of. am I being a good therapist? Am I providing value or is this something they could do at home? Right. So and if it's something they can do at home, I think we need to make sure we're checking. We're still checking in with them. We're updating their home program.
Communicating Therapy Value
00:04:56
Miranda Materi
And we're adding new things for them as opposed to just saying, oh, they're non-compliant. It just could be that they're not seeing value in the services or maybe there's a lack of understanding of why they need to come in. And as a therapist, have we done a good job providing the rationale for why they're coming in and what we're doing?
00:05:12
Miranda Materi
And what are what are the long-term implications of not coming?
00:05:13
josh MacDonald
yeah
00:05:15
Miranda Materi
What have we seen? What is our experience?
00:05:17
josh MacDonald
Yeah. Yeah, you're right. It's about patient education and our therapists. I wanna say selling our services. That sounds kind of like used car salesman, but being an advocate for like, hey, there's a value to this. and And if you think you can do it on your home, then I'm not doing a good job saying like, here's how I would progress you. Here's the manual stuff that you just can't do to do for yourself sometimes.
00:05:37
josh MacDonald
And so you're right. Making them aware of, hey, going in is a value in and of itself. Yeah.
00:05:42
Miranda Materi
And then if it's not, if they really can do it at home, then making sure that you're giving them a good program for home and checking in with them.
00:05:42
josh MacDonald
Yeah.
00:05:49
josh MacDonald
Yeah, yeah. yeah I was telling Miranda, we had a case just the other day where the patient had been coming to us for a while with a distor radius fracture, was very, very stiff and did not really understand how much to push herself at home with home program. So she was doing her home program, but not really getting the value out of it, but coming in very consistently. And then she just fell off and stopped coming in.
00:06:10
josh MacDonald
I reached out to her um and she said, the therapist that I went in and and spoke to the last two times told me in a very negative way, I was not going to get any range of motion back.
00:06:20
josh MacDonald
Well, I know the staff, and i know there's absolutely no way they told her that because she had been seeing some changes lately. She had been very, very stiff and was starting to see some functional progressions and strength progressions, even if not directly range of motion.
00:06:33
josh MacDonald
And she said her PA, a who had been an absolute jerk the whole time and refused to write scripts for us and told us we just needed to make her hurt more and push her more aggressively, was suddenly saying, well, maybe you are making great changes. Maybe you could just do it at home all by yourself.
Patient Perception and Clinic Reputation
00:06:47
josh MacDonald
So come back in six weeks. And we'll see if that's sufficient. And so now this patient thinks she, she heard something and her brain turned it into a negative, like they're telling you I'm not going to change when we had been so ultimately positive with this person, just because she was just kind of that person that needed a positive voice.
00:07:04
josh MacDonald
We can't do anything about it. If she doesn't want to come in and she heard something that, so we say, I'm sorry that, that that's what you heard, but if you need anything else, you let us know. And we're just here for you when you need it. There's sometimes there's just nothing you can do.
00:07:15
Miranda Materi
yeah I think that's an interesting point that you bring up about how the patient heard something different than what the therapist probably was saying. And um I was reading a book about communications and they were saying that actually happens ah high, high percentage of the time in any everyday communication, you and I communicating, us communicating with the patients.
00:07:31
josh MacDonald
Thank you.
00:07:34
Miranda Materi
So I think it's really um interesting, you know, like they, they may understand 80% or 20% of what we said and misunderstand 80%. It was the statistics are kind of staggering and it's interesting, but then checking in with the patient and seeing, did they hear what I'm actually saying?
00:07:47
josh MacDonald
ah
00:07:51
Miranda Materi
And did they understand it? Right. So having that patient um be able to have the opportunity to convey back to you, I think is really important.
00:08:00
josh MacDonald
That's a great point. Yeah. And we had all had the three of us had all had the essentially the same conversation. She, you know, the patient said, how am I doing? How's my range of motion? we take measurements? And we say like, you're doing great.
00:08:11
josh MacDonald
We're not seeing as much changes as maybe we'd like, and we may not get to full range, but you're doing great. We try to do that, like ah the, the correction sandwich, right? Where you do a positive, a positive, and maybe the negative in the middle, but it's surrounded by positives.
00:08:18
Miranda Materi
Yeah.
00:08:22
josh MacDonald
And she heard something different. And I don't know if that stood in her brain after she left and it turned into something negative. I know the therapist didn't tell you not to see any range of motion because that's not the way we function in our clinic. We would never say that.
00:08:36
josh MacDonald
And that's not how this patient was progressing, but that's what she heard. And, and we talked about, well, maybe you misheard her. Nope. That's exactly what you said. Okay. There's no winning that argument and saying, nah, that's not going to happen.
00:08:48
Miranda Materi
Right.
00:08:49
josh MacDonald
Yeah. But just saying like, we're here for us if you need us. Yeah.
00:08:53
Miranda Materi
Yeah, yeah, well, you're right. I'm sorry that that was that experience that you had, right? Because it's ultimately what she heard, right? In her mind.
00:09:00
josh MacDonald
yeah Yeah.
00:09:01
Miranda Materi
No matter how, you know, we'll be like, gosh, that's just crazy that she thinks that, right? But that is really what she is thinking.
00:09:06
josh MacDonald
Yeah. Yeah. And that's how good clinics end up sometimes with bad, bad press, bad Google reviews, whatever it is, because someone heard something that wasn't said and that can explode into something. And so I'm, I'm always hesitant when someone, when a patient comes in and says, oh, I had a bad experience over here.
00:09:25
josh MacDonald
I tell my staff, be careful because that may be just based on perception, or it may be that you're going to be the next one that's bad mouth the next time around. Perception is so much of reality
Setting Realistic Expectations
00:09:36
josh MacDonald
for, for a lot of our patients.
00:09:36
Miranda Materi
Yeah, it definitely is. And I think that was part of motivational interviewing too, is asking, well, even if they did have a bad experience at the other clinic, well, what was bad about it or what did you not like about it? Because then you can make those adjustments in your own treatment, right?
00:09:50
Miranda Materi
So what, and then like, okay, I know that that was a bad experience for them.
00:09:50
josh MacDonald
Yeah. Yeah.
00:09:53
Miranda Materi
So we can change or adapt what we're doing slightly and to offer ah better service for them.
00:09:58
josh MacDonald
yeah And sometimes it's about listening to the, what they're, what the undertones of what they're saying are. If they say, oh, they never gave me enough individual time. They were always so crazy busy that they couldn't.
00:10:09
josh MacDonald
Okay, well then if we're going to help this patient and keep them coming in and engaged in therapy, then I need to maybe schedule them a less busy time or not double book myself or kind of listening to some of those subtle things to say like, how are we going to keep this patient coming so that they can get better?
00:10:24
Miranda Materi
And then ask that question later, like, hey, do you feel like you're getting enough personalized time? Do you feel like I'm working? You know, like you can definitely ask those things. And I feel like when you ask them and they say, yes, I'm getting enough personalized times and they're not going to be upset, right? Because they've said it out loud.
00:10:37
josh MacDonald
Yes. Yes.
00:10:39
Miranda Materi
Yeah.
00:10:39
josh MacDonald
and ats the yeah And at the same point, we can't totally cater to that. Sometimes those patients want something that is unrealistic. I had a patient say, I'm only going to come here if you see me privately in a private treatment room with no one else around. And I have your dedicated time. like, I have a busy clinic.
00:10:54
josh MacDonald
I'm sorry. I just don't think I'm the right place for you. Like we can't meet everyone else's needs, um whether it's getting them to come in all the time or, or their quirks and preferences. It's sometimes it's just not going to happen.
00:11:05
josh MacDonald
Yeah.
00:11:06
Miranda Materi
yeah yeah we Yeah, we try. i think we've had those patients where we try really hard to meet those expectations. But I think if you're fair and you set them up early, like we had a patient that didn't want to come in when anybody else was in the clinic because she was afraid of germs and things like that. So we always had them in the morning and then we'd get them out by a certain time. But there became a point in time where just the patient kept asking for more and more. And you're like, no, you know we we did that for you and we're happy to continue to do that, but we can't add more stuff in.
00:11:36
josh MacDonald
Yeah. Yeah. Professional boundaries need to go both ways and you need to be able to say like, yeah, I want you to come in and get value out of the service. But at some point we've got to draw a line because we have to run a practice and serve other patients and keep our own sanity too.
Conclusion and Contact Information
00:11:50
Miranda Materi
Yeah, like if someone's walking in the door, you know, that we had like didn't expect, then that's, you know, that can happen, right? Like, you can't that yeah get upset with us when those are variables we can't control.
00:11:57
josh MacDonald
Yeah. Yeah. Walk over is even someone early. Yeah.
00:12:04
josh MacDonald
Yeah.
00:12:05
Miranda Materi
Yeah.
00:12:05
josh MacDonald
Yeah. Well, dealing with patients is a whole bag of, of confusion and, and drama sometimes, but hopefully this is helpful for you guys. If you have any thoughts or input, or if you have any questions, you can reach us on our social media platforms and therapy Academy, or you can email us info at handtherapyacademy.com.